Tuesday, April 8, 2008

Case of the Week – TMJ Headache

Patient: 35 year old male police officer

Patient presents complaining of nagging headaches located on both sides of his head. The pain is throbbing but not pulsating; pain can spread to the forehead as the condition worsens. He has headaches 2-3 times per week, but there is no time of day or activity that seems to aggravate the symptoms. He has tried Advil, which helps, and increasing his water intake. The frequency of the headaches is increasing and he is concerned the pain will begin to affect his judgment at work. The patient has had temporomandibular joint (TMJ) issues in the past and has been prescribed a night guard by his dentist. He clenches and grinds his teeth in his sleep, causing him to wear through one night guard per year.

Physical examination reveals abnormal TMJ gait, with the jaw swinging out to the left upon opening and following the same course upon return. The action is accompanied by popping in the right TMJ. The TMJ muscle group (masseter, temporalis, medial and lateral pterygoids) is tight and tender with trigger points bilaterally. Trigger points in the lateral pterygoids reproduce the patient’s headache. There is restricted motion of the left TMJ and the right C1-2 vertebral facet joint. Other testing, including vascular, neurologic and orthopedic testing of the neck and head are within normal limits.

Discussion: In this case, the patient had increased muscle tension in the jaw complex, causing a referral headache similar in mechanism to a tension headache. As the muscles tighten, the TMJ is compressed which decreases its ability to move properly and causes pain and inflammation. Our goal here is to first release the tension in the muscles and joints of the complex, including the upper cervical vertebrae. This will help the patient get out of pain. The second and more important goal is to find the cause of muscle tension and eliminate it. Without finding the root cause, the problem will continue to crop-up, over and over again.

Many people don’t realize that it is possible to massage the muscles of the jaw from inside the mouth. This is really the best way to access them, especially the pterygoid group, and can be a very simple but effective procedure. The doctor uses a gloved finger to gently apply pressure to the areas of tension until the tension is released, just as in traditional myofascial release. Once the muscles of the jaw are relaxed, the TMJ itself can be adjusted. In this patient’s case, the left joint was not moving well, causing the right joint to be hypermobile. We adjusted the patient’s left TMJ using gentle chiropractic manipulation and also adjusted the upper cervical joints to complement the new motion in the jaw.

It is important to note that the TMJ and the upper cervical joints have a very close relationship. Often, adjusting only the neck will relieve the tension in the TMJ. Other times, the TMJ is really the source of neck pain and the TMJ should be addressed first. In this case, the TMJ was the primary issue, so the treatment to the neck was only in relation to the TMJ’s needs.

It is also very common for people to suddenly develop TMJ problems after protracted dental work, orthodontics or a motor vehicle accident.

Outcome: With a course of myofascial release and chiropractic manipulation, the patient’s headaches decreased and finally disappeared within 3 weeks. In this case, we found that the patient’s night guard from his dentist was not fitted properly. This, combined with increased stress at work, was causing irritation to the muscles and resulting in headaches. With a new night guard and stress-reduction techniques, the patient was had a full recovery.

Exercise of the week: If you suspect you have TMJ pain, try this: Wrap the eraser end of a pencil in a sturdy paper towel, creating a bulb of about 2cm in thickness. Using the writing end of the pencil as a handle, place the bulb at the very back of the mouth, to the side where your teeth end and the soft tissue of the jaw begins. Bite down slowly on the bulb. This creates a gapping motion in the TMJ itself and can give pain relief to a compressed joint. Make sure to try both sides. If this exercise provided pain relief for your jaw, you may want to seek a chiropractic consultation to evaluate your TMJ complex.Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.Suggestion of the week: Evaluate your own TMJ gaitStand facing a mirror and very slowly open and close your mouth repeatedly. Open it all the way and close it all the way. Watch your chin. Your chin should follow a straight line up and down. If it curves off to one side in a C shape or S shaped pattern, your TMJs are not functioning properly. Also, if you have significant clicking or popping in your jaw with opening and closing the mouth, it can indicate a problem with the TMJ. Try it today and see how your jaw is doing!Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

About Me

Chiro-Health, Inc is a downtown San Francisco clinic providing expert care in chiropractic, acupuncture, massage and physical therapy specializing in spine pain, back pain, neck pain and extremity pain. We are passionate about bringing the wonders of alternative healthcare to as many people as possible